In the second part of her blog about our new strategy, Sophie Lutter discusses what we'll be doing on clinical trials and advanced prostate cancer.
I know how lucky I am to have never had a close personal encounter (either myself or my immediate family) with cancer. And quite frankly, I can’t imagine what must go through your mind when you’re told that you – or your loved one – has an incurable disease. But over 6,500 men and their families a year in the UK face that moment of truth when they’re given a diagnosis of advanced prostate cancer.
Ian Liston was one of those men. In 2005, he was told that the hormone therapy he’d been given to control his prostate cancer had stopped working, and there wasn't anything more his oncologist could do for him. They could help manage the symptoms, but as far as the cancer was concerned, it was game over.
There used to be no treatments for advanced disease once hormone therapy stopped working – now there are five
That was just over a decade ago and, since then, the science has shifted significantly. There used to be no treatments for advanced disease once hormone therapy stopped working – as unfortunately, it still inevitably does. Now there are five: chemotherapy, in the form of docetaxel and cabazitaxel; second-line hormone therapies, such as abiraterone and enzalutamide; and an injectable form of radiotherapy that specifically targets cancer that has spread to the bone, radium-223.
Thanks to advances in these and other treatments, Ian is not only alive today but well. In fact, he volunteered for clinical trial after clinical trial for new treatments and technologies. Some worked better than others and then finally he was given the all clear.
At the moment, good news stories like Ian’s are the exception when it comes to advanced disease. Over the next 10 years, we want to make them the rule – and the experts see several ways of this happening.
Professor Malcolm Mason, a clinical oncologist from Cardiff, says: “We’re on the cusp of looking at advanced disease in a new way. It’s time to see how we can open this issue right up.”
We agree, and one of the key ways we’re planning to do this is with a large scale ‘stratified medicine’ clinical trial. This means looking at the individual genetic characteristics of a man’s prostate cancer, and assigning him to a clinical trial of a type of treatment that aims to target that particular genetic profile. So far it’s early days for this trial. We’ve brought a big group of researchers and potential funding partners together to discuss what such a trial might look like, and they’re now working on a research proposal. Watch this space!
Now is really the time to bring all this together and change how we think about advanced disease. It’s not unrealistic to think that one day it will be curable
We know that clinical trials like the STAMPEDE trial are making massive inroads into determining whether we can get a better effect from existing treatments – like docetaxel chemotherapy – if we give them earlier in the treatment pathway. We hope that this stratified medicine trial will be a key follow-on step from this, working out not just the best time to use the treatments we’ve already got, but which patients are most likely to benefit too.
Charlotte Bevan, Professor of Cancer Biology at Imperial College London, honed in on another key area that improving treatments needs to concentrate on. “We need to make sure that the biomarkers we use to identify aggressive disease and assign treatments for it are rational,” she says. “That means understanding exactly how that particular gene or protein works, and what exactly its role is in driving disease. We also need to make sure that we target our treatments towards the cancer cells more precisely, to minimise damage to surrounding tissue.” This in turn should reduce side effects.
There’s already so much work going on in this area – we’ve already talked about breakthroughs in treating men with olaparib, a drug originally intended for women with ovarian cancer, and promising leads in the area of cancer immunotherapy. Now is really the time to bring all this together and change how we think about advanced disease. It’s not unrealistic to think that one day it will be curable.
Prostate Cancer UK appoints Dr David Montgomery to lead our research programme by bringing his experience in medicine and the pharmaceutical industry to help ensure that men get the benefits of breakthroughs in the lab as soon as possible.